Validation of the PRAETORIAN Score in a large S-ICD collective – usefulness in clinical routine

Florian Doldi (Münster)1, G. Frommeyer (Münster)1, A. Löher (Münster)2, C. Ellermann (Münster)1, J. Wolfes (Münster)1, F. Güner (Münster)1, M. Zerbst (Münster)1, H. H. Engelke (Münster)1, D. Korthals (Münster)1, F. Reinke (Münster)1, L. Eckardt (Münster)1, K. Willy (Münster)1

1Universitätsklinikum Münster Klinik für Kardiologie II - Rhythmologie Münster, Deutschland; 2Universitätsklinikum Münster Herz- und Thoraxchirurgie Münster, Deutschland


Objective and Background: To assess the risk of failed defibrillation of ventricular fibrillation (VF) with the totally subcutaneous implantable cardioverter defibrillator (S-ICD), the PRAETORIAN Score has been proposed. We aimed at validating this score in a large daily-life S-ICD collective and at identifying potential predictors of defibrillation failure.

Methods and Results: An analysis of 398 consecutive patients after S-ICD implantation in our center was performed. Patients were mostly male (n=268; 67.3%) with a mean age of 42.4±15.9 years and a BMI of 25.9±4.8 kg/m2. Successful intraoperative defibrillation testing (DFT) with the first ICD shock was observed in 264 (66.3%) patients. Most of the remaining patients were successfully tested with the second (reverse polarity) or third (80 instead of 65 Joules of shock energy) intraoperative shock (127; 31.9%), only in 7 patients, no successful shock was applied. In these patients, S-ICD repositioning was performed until successful testing. The majority (n=88, 65.7%) of defibrillation failures happened before 2015 with the first S-ICD generation. The PRAETORIAN score proved to be an independent predictor for defibrillation failure (OR 1.007, CI 1.003, 1.011, p 0.001). BMI was not predictive in our multivariate analysis, but presence of a hypertrophic cardiomyopathy (OR 2.6; CI 1.3, 4.4, p= 0.004) was predictive for at least one unsuccessful defibrillation in a multivariate regression analysis.

Conclusion:  The PRAETORIAN score was found to be a useful and valid predictive tool for S-ICD defibrillation success. Correct electrode placement appeared to be more important than increased BMI for prediction of defibrillation failure. Patients with hypertrophic cardiomyopathy were at increased risk for defibrillation failure.

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